Tuesday, March 09, 2010

A new strategy to help women and children with HIV/AIDS

About 30 years into the HIV/AIDS epidemic, a new strategy is being launched to better respond to the needs of women and children.

The research agenda -- called Asking the Right Questions – includes 20 specific recommendations to expand and improve care and treatment. The announcement coincides with Monday’s International Women’s Day and is a joint effort by the International AIDS Society (IAS), U.N. agencies, researchers and civil society.

IAS Executive Director Robin Gorna says, “We’re nearly three decades into the epidemic and we have the depressing news that AIDS is now the leading cause of death of women of reproductive age across the globe,” she says.

It wasn’t always that way

“Three decades ago, very few women were infected with HIV. It was a minority issue. But sadly, as HIV has taken its increasing toll on women, the pace of research and the response really hasn’t kept up,” she says.

While “excellent treatments” are available, she says, which can prolong life, many have “not been properly researched on women’s bodies.”

As a result, the full effects of those treatments on women are not known.

“Now that more and more women are accessing treatment, what we still don’t know is how we can best get women into care and how we can make sure that care is integrated,” she says.

That includes, she says, ensuring HIV positive pregnant women get the best health care, while at the same time providing the necessary drugs to prevent HIV transmission to their babies.

What happened along the way

“There are very good reasons for not including women in early research. Doctors and pharmaceutical companies are always very worried about how drugs might affect the growing fetus. And of course we have the terrible history of Thalidomide, where women unintentionally took drugs, which led to side effects in their babies,” she says.

This side effects included severe deformities, including missing limbs. The drug was sold between 1957 and 1961, before being pulled from the market.

“No one ever wants that to happen again. What that means is as an extreme caution,” she says. “Women of reproductive age are not included in clinical trials.”

In the event women of child bearing age are included, they must drop out of clinical trials if they become pregnant.

“For example, one of the drugs that is now used as first-line therapy throughout the world – one of the best drugs we have in combination (therapy) to combat AIDS – is recommended not to be used in women of reproductive age. And yet they are in many countries the majority of people with HIV,” she says.

Kids need special care

“One of the other things we’re looking at is the effect on children. Now in the rich world…we’ve basically eradicated transmission of HIV from pregnant women to their babies. And that’s brilliant news. Sadly, in many of the poorer countries of the world, the opposite is true. And hundreds of thousands of babies are born with HIV every year,” Gorna says.

The head of the International AIDS Society calls it “tragic” that drugs are not available in the “correct formulation” in the developing world.

“We have the drugs, but they need to be mini pills or syrups or a range of other innovative delivery mechanisms. And quite simply, there isn’t any economic rationale for many companies to make those products in that style,” she says.

The IAS, U.N. and other groups are calling on the pharmaceutical industry to increase its research and development of pediatric AIDS drugs “to make sure that these children, who are being born with HIV, can stay alive,” she says.

The IAS, UNICEF and others have set a goal of no more children being born HIV positive by 2015. Gorna says it’s possible, but it will take money and political will.

Universal access

Gorna is in London for a Tuesday meeting on universal access to HIV care, treatment and prevention. In 2005, at the G8 summit in Gleneagles, Scotland, leaders set a goal to provide such access by 2010.

“In 2005, the U.K. led the charge for the G8 and then the whole world at the U.N. to commit to this ambitious goal…. It’s sad, but truly the fact, that we’re about a third of the way there,” she says.

The London meeting, Gorna says, “Is to try very hard to reignite the energy and the passion to achieve that goal of universal access to HIV treatment, prevention and care. We estimate there are about 10 million people who need HIV treatment today and are simply not able to access it.”

Gorna says Canada is hosting both the G8 and G20 summits this year, but so far has not included HIV/AIDS on the summits’ agendas.

African leaders and HIV positive Africans are expected to address Tuesday’s gathering in London about the problems they face.

“My suspicion is that what they’re going to say we need more money. We need to make sure that this remarkable momentum over the last five years does not slow down, that the funding is not flatlined. And that we don’t get into an unhealthy competition with other diseases or with climate change,’ she says.

She says the need for universal access is no less great today than it was in 2005.